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Effects of coenzyme Q10 on statin-induced myopathy: a meta-analysis of randomized controlled trials

Maciej Banach, Corina Serban, Amirhossein Sahebkar, Sorin Ursoniu, Jacek Rysz, Paul Muntner, Peter P Toth, Steven R Jones, Manfredi Rizzo, Stephen P Glasser, Gregory Y H Lip, Simona Dragan, Dimitri P Mikhailidis
Mayo Clinic Proceedings 2015 90(1):24-34

Bibliography

PubMed
PMID 25440725
DOI
10.1016/j.mayocp.2014.08.021
Funding
A specific funding statement for this meta-analysis was not identified in the accessible PubMed record checked during this audit.
Competing interests
A specific conflict-of-interest statement was not identified in the accessible PubMed record checked during this audit; no absence of conflicts is inferred.

Study snapshot

DesignMeta-analysis of randomized controlled trials
ModelSystematic review and meta-analysis of randomized controlled trials evaluating CoQ10 supplementation for statin-induced myopathy, with separate pooled analyses of muscle pain and creatine kinase.
Sample6 randomized controlled trials; 302 statin-treated patients overall. Five studies/253 participants contributed muscle-pain data and five studies/226 contributed creatine-kinase data.
InterventionCoQ10 supplementation versus control/placebo in statin-treated adults with muscle symptoms; doses and treatment protocols varied across trials.
Duration
EndpointsMuscle pain; Plasma creatine kinase; Dose-effect meta-regression; Statin-induced myopathy symptoms

What the study showed, in plain terms

This 2015 meta-analysis pooled six randomized trials with 302 statin-treated patients. It did not find a statistically significant benefit of CoQ10 for either muscle pain or creatine kinase.

Muscle pain showed a nonsignificant trend favoring CoQ10 (SMD -0.53, 95% CI -1.33 to 0.28; p=0.20). Creatine kinase was also unchanged (MD +11.69 U/L, 95% CI -14.25 to 37.63; p=0.38). Meta-regression did not identify a dose-response relationship for either outcome.

This synthesis searched studies only through May 2014 and therefore predates some later statin-myalgia trials. It is important as an early negative pooled analysis, but it should be read alongside the later 2018 positive meta-analysis and 2020 negative meta-analysis rather than treated as the final word.

Key findings

Muscle pain: 5 studies/253 participants; SMD -0.53, 95% CI -1.33 to 0.28, p=0.20—no statistically significant benefit.

Creatine kinase: 5 studies/226 participants; MD +11.69 U/L, 95% CI -14.25 to 37.63, p=0.38—no significant reduction.

Dose-effect meta-regression: CK slope -0.001 (95% CI -0.004 to 0.001; p=0.33) and muscle-pain slope +0.002 (95% CI -0.005 to 0.010; p=0.67), showing no detectable dose-response relationship.

Search window: MEDLINE, Cochrane Library, Scopus and EMBASE from November 1987 through 1 May 2014.

Overall conclusion: available randomized evidence at that time did not support a significant CoQ10 benefit for statin-induced myopathy.

What this study can and cannot tell us

Only six trials and 302 patients were available, with even fewer contributing to each pooled outcome.

Definitions of statin myopathy/myalgia, CoQ10 dose, symptom scales, statin regimens and treatment duration varied across trials.

The search ended in May 2014, so later trials—including the rigorous confirmed-myalgia Taylor study—were not included.

Muscle pain was largely subjective and the pooled estimate had a wide confidence interval compatible with both meaningful benefit and no benefit/harm.

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Dr. Khaled Mahmoud, MBBChCritical Care Medicine, Longevity Science & Editorial Direction Dr. Amr Yasser, PhDCardiometabolic, Musculoskeletal, Gut & Bioavailability Dr. Abdulla Mostafa, PhDCellular Senescence, Neurological, Mitochondrial & Brain-Ageing Biology